發(fā)布時(shí)間：2018-03-14 21:08

  本文選題：直腸癌　切入點(diǎn)：膀胱體積　出處：《河北醫(yī)科大學(xué)》2013年碩士論文　論文類型：學(xué)位論文

【摘要】：目的： 應(yīng)用圖像引導(dǎo)放射治療技術(shù)，觀察直腸癌患者仰臥位熱塑體膜固定下膀胱邊界的運(yùn)動(dòng)，研究放射治療中膀胱的體積大小和形狀變化特征，及對(duì)直腸癌術(shù)后放療靶區(qū)和周圍正常組織劑量學(xué)的影響。 材料與方法： 收集2010年5月至2012年10月期間在我科行直腸癌術(shù)后同步放化療或單純術(shù)后預(yù)防照射的患者12例。12例患者均采用仰臥位熱塑體模固定，大孔徑螺旋CT掃描定位，將定位掃描圖像傳至CMS Xio4.4治療計(jì)劃系統(tǒng)，然后在定位CT圖像上勾畫臨床靶區(qū)及正常組織，并制定5野調(diào)強(qiáng)計(jì)劃。12例患者均于精確擺位后，實(shí)施放射治療前行KV級(jí)CBCT掃描，每周2-3次，共獲取119幅CBCT圖像。將收集的CBCT圖像與定位CT圖像進(jìn)行融合配準(zhǔn)，并在CBCT圖像上勾畫正常組織和靶區(qū)。依照CBCT圖像的組織輪廓，在CT圖像上制定與原始治療計(jì)劃相同射野角度和優(yōu)化條件的新計(jì)劃。觀察膀胱在不同充盈狀態(tài)下各壁形狀及位置的變化，分析治療過程中膀胱體積和形狀的變化與靶區(qū)大小、正常組織受照劑量間的關(guān)系。 結(jié)果： 患者采用仰臥位、熱塑體膜固定方式下，膀胱上壁、前壁、左壁、右壁、300后壁(后上方)、00后壁(正后方)、-300后壁(后下方)的移動(dòng)范圍分別為1.039±1.0038cm、0.281±0.2373cm、0.350±0.3151cm、0.622±0.4440cm、0.592±0.4974cm、0.615±0.4964cm、0.247±0.2527cm。12例患者膀胱體積與臨床靶體積之間均呈負(fù)相關(guān)性，P0.05。研究膀胱體積大小與周圍正常組織受照劑量之間的關(guān)系，發(fā)現(xiàn)5例患者膀胱體積與結(jié)腸V35呈負(fù)相關(guān)，2例患者膀胱體積與結(jié)腸V40呈負(fù)相關(guān)，5例患者膀胱體積與結(jié)腸平均受照劑量呈負(fù)相關(guān)，P0.05；7例患者膀胱體積與小腸V35呈負(fù)相關(guān)，7例患者膀胱體積與小腸V40呈負(fù)相關(guān)，6例患者膀胱體積與小腸平均受照劑量呈負(fù)相關(guān)，P0.05；3例患者膀胱體積與膀胱V35呈正相關(guān)，7例患者膀胱體積與膀胱V40呈正相關(guān)，3例患者膀胱體積大小與膀胱平均受照劑量呈正相關(guān)，P0.05。在分次治療中膀胱體積比定位膀胱體積增大時(shí)，12例患者的膀胱受照劑量均較原治療計(jì)劃增加。 結(jié)論: 1直腸癌患者放射治療采取仰臥位、熱塑體模固定方式，膀胱前壁移動(dòng)度較小，上壁、后壁及右壁移動(dòng)度較大； 2膀胱充盈程度不同勾畫的直腸癌術(shù)后預(yù)防靶區(qū)也不同，膀胱排空狀態(tài)下淋巴引流區(qū)顯露較好，勾畫的臨床靶區(qū)體積較大，反之，勾畫的臨床靶區(qū)體積減小。 3膀胱體積大小與結(jié)腸、小腸受照劑量間存在負(fù)相關(guān)性；隨著膀胱體積一定程度的增加，膀胱V40體積增加。 4若定位時(shí)排空膀胱，，調(diào)強(qiáng)放射治療計(jì)劃能夠保證周圍正常組織在其耐受劑量范圍內(nèi)，分次治療間膀胱充盈程度增加時(shí)，膀胱受照劑量會(huì)增加。
[Abstract]:Objective:. The motion of bladder boundary was observed under supine thermoplastic membrane fixation in rectal cancer patients by image-guided radiotherapy, and the changes of bladder volume and shape during radiotherapy were studied. And its effect on postoperative radiotherapy target area and normal tissue around rectal cancer. Materials and methods:. From May 2010 to October 2012, 12 patients with rectal cancer received simultaneous radiotherapy and chemotherapy or only postoperative prophylactic irradiation were treated with supine thermoplastic mode fixation and large aperture spiral CT scanning. The localization scanning image was transferred to the CMS Xio4.4 treatment planning system, and then the clinical target area and normal tissue were drawn up on the location CT image, and the 5 field intensity modulation plan was made. After accurate placement, KV grade CBCT scan was performed before radiotherapy. A total of 119 CBCT images were obtained 2-3 times a week. The collected CBCT images were fused with the localized CT images, and the normal tissues and target areas were drawn on the CBCT images. According to the tissue contours of the CBCT images, A new plan with the same projection angle and optimized conditions as the original treatment plan was made on CT images. The changes of the shape and position of each wall of bladder under different filling conditions were observed, and the changes of bladder volume and shape and the size of the target area were analyzed during the treatment. The relationship between radiation doses in normal tissues. Results:. Supine position, thermoplastic membrane fixation, upper wall of bladder, anterior wall, left wall, The moving range of the posterior wall of the right wall was 1.039 鹵1.0038 cm-1 0.281 鹵0.3151 cm-1 0.350 鹵0.3151 cm-1 0.592 鹵0.4974 cm0.62 鹵0.4964cm0.247 鹵0.2527 cm.12 cases of clinical target volume and bladder volume were negatively correlated with the clinical target volume (P0.05). The relationship between exposure doses, It was found that there was a negative correlation between bladder volume and colon V35 in 5 patients and a negative correlation between bladder volume and colon V40 in 2 patients and a negative correlation between bladder volume and average irradiation dose in colon in 5 patients and a negative phase between bladder volume and V35 in small intestine in 7 patients. There was a negative correlation between bladder volume and small intestine V40 in 7 patients and a negative correlation between bladder volume and mean dose of small intestine in 6 patients. There was a positive correlation between bladder volume and bladder V35 in 3 patients and a positive correlation between bladder volume and bladder V40 in 7 patients. There was a positive correlation between bladder volume and average dose of bladder irradiation in 3 patients (P 0.05). When the volume of bladder was larger than that of fixed bladder, the dose of bladder exposure in 12 patients was higher than that of the original treatment plan. Conclusion:. 1 the patients with rectal cancer were treated with supine position, thermoplastic mod fixation, lower movement degree of the anterior wall of bladder, greater degree of movement of the upper wall, posterior wall and right wall; 2the prevention target area of rectal cancer with different bladder filling degree was different. The lymph drainage area was better exposed under bladder emptying, and the volume of clinical target area was larger, whereas the volume of clinical target area was decreased. (3) there was a negative correlation between the volume of bladder and the dose of colon and small intestine, and the volume of bladder V40 increased with the increase of volume of bladder to some extent. (4) if bladder was emptied during localization, the intensity modulated radiotherapy plan could ensure that the bladder irradiation dose would increase when the bladder filling degree increased in the range of tolerance dose of the surrounding normal tissue.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R735.37;R730.55

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 謝大業(yè),章祖成,羅旭耀;~(125)I籽永久性植入治療7例癌癥療效[J];第二軍醫(yī)大學(xué)學(xué)報(bào);2000年02期

2 韓蕾;王文玲;毛必靜;洪衛(wèi);董紅敏;李媛媛;;膀胱充盈狀態(tài)對(duì)直腸癌盆腔調(diào)強(qiáng)適形放療靶區(qū)和鄰近危及器官影響的臨床研究[J];護(hù)士進(jìn)修雜志;2010年16期

3 夏紅強(qiáng);沈文同;金冶寧;;直腸癌術(shù)后共面等分設(shè)野調(diào)強(qiáng)放療和三維適形放療計(jì)劃的比較研究[J];中華腫瘤防治雜志;2011年07期

4 陳衛(wèi)軍;梁曉東;劉艷梅;應(yīng)申鵬;倪琳琴;;CT增強(qiáng)定位掃描對(duì)放療劑量的影響[J];腫瘤學(xué)雜志;2010年06期

5 何林;;三維適形放療與常規(guī)放療治療直腸癌復(fù)發(fā)患者的臨床分析[J];中國醫(yī)藥指南;2012年08期

6 羅開元,李波,楊嶸,王明春,劉文卓,曹衛(wèi)弘,黃明龍;~(125)I粒子組織間放射治療惡性腫瘤的臨床應(yīng)用[J];中華醫(yī)學(xué)雜志;2001年12期

7 羅開元,邵慶華,楊國凱,毛文源,李波,楊嶸,段寶鳳,楊鏞,王明春,劉文卓;~(125)I粒子植入在低位直腸癌保肛術(shù)中的應(yīng)用[J];中華醫(yī)學(xué)雜志;2005年19期

8 邵永孚;重視直腸癌術(shù)后局部復(fù)發(fā)的預(yù)防[J];中國胃腸外科雜志;2000年04期

9 凌峰;張陽德;何剪太;張華;謝愛民;;手術(shù)前后輔助放射治療對(duì)直腸癌預(yù)后影響的Cox模型分析[J];中國現(xiàn)代醫(yī)學(xué)雜志;2007年03期

10 林霞;王嘉鵬;郭杰;王鐵君;;真空墊與熱塑體模在宮頸癌放療中擺位誤差比較[J];中國老年學(xué)雜志;2012年22期

相關(guān)博士學(xué)位論文 前1條

1 錢立庭;直腸癌適形放射治療的臨床和實(shí)驗(yàn)研究[D];中國協(xié)和醫(yī)科大學(xué);2004年

本文編號(hào)：1612926